Medical Audit SpecialistApr 2011 －Nov 2012TrailBlazer HealthcareDenison, TXPerformed post-payment review for medical necessity as part of TrailBlazer's contract with The Center for Medicaid and Medicare Services. Utilized various medical management software and writing skills for creation of detailed review and rationales for denials and resulting correspondence with Medicare providers. Sadly had to leave this position when TrailBlazer lost the Medicare contract to another vender and the Denison facility was closed.

Medical ReviewerMar 2010 －Aug 2010Global Health Provider NetworkOklahoma City, OKUtilizing chart review and nursing knowledge, analyzed hospital billing charges against medical documentation to determine accuracy in reporting for inpatient services. created detailed spreadsheets for all incorrectly reported procedures, medications, and DME charges accrued during inpatient hospital stays. Had to leave this position due to relocation to Texas after divorce.

Medical Review Audit SpecialistMay 2006 －Dec 2008Oklahoma Health Care AuthorityOklahoma City, OKWorked for the Oklahoma Health Care Authority, performing comprehensive medical chart review for medical necessity for outpatient services audits for the state's Medicaid certified providers. Office visits, procedures, physical, occupational and mental health therapies were included in the sampling for these audits. As part of a team, performed on-site comprehensive reviews across Oklahoma. Resigned to care for my terminally-ill father, which required relocation to Texas for four months

Nurse Review SpecialistNov 2005 －Mar 2006Oklahoma Foundation for Medical QualityOklahoma City, OKWorked as a medical chart review specialist as part of OFMQ's Medicaid contract with the state of Oklahoma. Utilized InterQual criteria to determine medical necessity for services performed by Medicaid certified providers, including procedures and inpatient stays. Had to leave to take a job with OHCA after OFMQ failed to secure renewal of their Medicaid contract with the state.

Telephonic Case ManagerApr 2005 －Oct 2005CompChoiceOklahoma City, OK

Worked as a telephonic case manager, guiding worker's compensation patients through the healing process to ensure a timely progression to optimum health, productivity and return to work for CompChoice clients. Utilized worker's compensation-specific medical management programs, along with interpersonal skills, nursing knowledge and expertise. Left this position to broaden experience in medical review at OFMQ.

Worked as a RN Health Care Finder for HealthNet as part of their contract with the TRICARE Military Health Program. Proudly assisted military members and their families in obtaining quality health care by obtaining appointments and appropriate health care services, utilizing provider contacts, as well as medical and nursing knowledge. Also performed pre-certification review and authorizations for requested services by military and TRICARE certified providers using appropriate InterQual review guidelines. Left after 7 years when TRICARE awarded the contract to Humana and all nursing positions were moved to centralized locations.

Performed duties as a Registered Nurse on the cardiac step-down unit, medical-surgical floor, pediatrics and intensive care units. Using the nursing care process, provided comprehensive care to patients during their hospitalization. Worked closely with all members of the care team, included doctors, medication techs, LVN's, physical, respiratory and occupational therapists, and nursing aides to provide optimal and quality patient care.

Julian Phillips

Charles Collins

Companies Worked For:

Portland Glass , RadioShack

JobTitles Held:

Inside Sales Representative , Assistant Manager

About this resume

Medical Chart Reviewer FROM Denison , Texas RESUME

This is a resume for a Medical Chart Reviewer in Denison, Texas with experience working for such companies as Recovery Audit Review Consulting Company and TrailBlazer Healthcare. The grade for this resume is 0 and is one of hundreds of Medical Chart Reviewer resumes available on our site for free. Use these resumes as templates to get help creating the best Medical Chart Reviewer resume.